29
Fighting Fraud. Improving Integrity and Quality. Saving Taxpayer Dollars.
| Date post: | 04-Jan-2016 |
| Category: |
Documents |
| Upload: | virginia-irwin |
| View: | 28 times |
| Download: | 0 times |
Fighting Fraud. Improving Integrity and Quality. Saving Taxpayer Dollars.
Fighting Fraud. Improving Integrity and Quality. Saving Taxpayer Dollars.
Mission Statement
Our mission is to enhance the integrity of the New York State Medicaid program by preventing and detecting fraudulent, abusive, and wasteful practices within the Medicaid program and recovering improperly expended Medicaid funds while promoting high-quality patient care.
2
Fighting Fraud. Improving Integrity and Quality. Saving Taxpayer Dollars.
Providers who identify Medicaid over-payments are obligated to return those funds.
Patient Protection and Affordable Care Act (ACA) Section 6402 of PPACA18 NYCRR 515.2
No other state agency has authority to process Medicaid self-disclosures (Public Health Law §§ 30, 31, and 32(18))
Background
3
Fighting Fraud. Improving Integrity and Quality. Saving Taxpayer Dollars.
Background (Continued)
Failure to self-disclose when finding a problem may expose the “person” to liability under the False Claims Act, including whistleblower actions, treble (i.e., three times the amount) damages, and penalties.
4
Fighting Fraud. Improving Integrity and Quality. Saving Taxpayer Dollars.
Why Self-Disclose?
Obligated by lawClaims covered by self-disclosure will not be
audited again for same issue and dates of service.
Six-year look-back periodProvider performs the audit, not OMIG
Less disruptive to provider
5
Fighting Fraud. Improving Integrity and Quality. Saving Taxpayer Dollars.
Why Self-Disclose? (continued)
Extended repayment terms possible for demonstrated financial hardship
No penalties or sanctions
6
Fighting Fraud. Improving Integrity and Quality. Saving Taxpayer Dollars.
Who Files the Self Disclosure?
Possibilities: The president, CEO, or CFO of the companyAttorney representing the provider The corporate compliance officer
7
Fighting Fraud. Improving Integrity and Quality. Saving Taxpayer Dollars.
When to Disclose
Under ACA, Medicaid overpayments should be reported and returned to OMIG: by the later of:
(a) the date which is 60 days after the date on which the overpayment was identified; or
(b) the date any corresponding cost report is due, if applicable.
8
04/20/23 9Fighting Fraud. Improving Integrity and Quality. Saving Taxpayer Dollars.
9
At www.omig.ny.gov
9
04/20/23 10Fighting Fraud. Improving Integrity and Quality. Saving Taxpayer Dollars.
10
10
Everything you need is on this page. Start with the checklist; refer to guide to provider overpayment reporting and data request from providers.
Fighting Fraud. Improving Integrity and Quality. Saving Taxpayer Dollars.
Information on OMIG Web Site
OMIG Self-Disclosure ProgramSubmission ChecklistGuidelines for Provider Overpayment
ReportingProvider Universe and Sample Request
11
Fighting Fraud. Improving Integrity and Quality. Saving Taxpayer Dollars.
Self-Disclosure Checklist (Partial) from OMIG Web Site
Self-Disclosure Submission GuidelinesA self-disclosure submission requires both a letter and a claim file(s) of impacted Medicaid claims.Submission LetterComplete description of circumstances surrounding the disclosure including:Provider nameMedicaid MMIS ID and NPI number of the billing providerThe error that occurredHow the error was foundAny relevant facts including total amount billed and amount of overpayment by Medicaid
12
Fighting Fraud. Improving Integrity and Quality. Saving Taxpayer Dollars.
Self-Disclosure Checklist (Partial) from OMIG Web Site (Continued)
Identify : The time period the claims error encompasses Actions taken to stop the error and prevent
recurrence Personnel involved in the error occurrences, those
who discovered the problem, and those involved in Rectifying the problem Legal and Medicaid program rules implicated Disclosure contact person name, phone number, and
both correspondence and email addresses
13
Fighting Fraud. Improving Integrity and Quality. Saving Taxpayer Dollars.
How to Disclose
Contact the OMIG Self Disclosure Unit by letter to:
NYS Office of Medicaid Inspector GeneralSelf-Disclosure Unit800 North Pearl StreetAlbany, New York 12204-1822
E-mail: [email protected]
Fighting Fraud. Improving Integrity and Quality. Saving Taxpayer Dollars.
How to Disclose (continued)
Through OMIG’s Recovery Audit Contractor (RAC):
HMS PORTal •https://ecenter.hmsy.com/shr/controller
15
Fighting Fraud. Improving Integrity and Quality. Saving Taxpayer Dollars.
How to Disclose (continued)
For assistance filing a disclosure See the OMIG Web site Reference the Self-Disclosure submission
documents Call for advice: 518-402-7030, ask for Self-
Disclosure
16
Fighting Fraud. Improving Integrity and Quality. Saving Taxpayer Dollars.
Examples of What to Disclose
Claims billed in errorBilling software errorDuplicate billingExcluded individualForged documentationFraudulent time billed
17
Fighting Fraud. Improving Integrity and Quality. Saving Taxpayer Dollars.
Examples of What to Disclose (continued)
Inadequate credentialsIncorrect rate code usedServices billed not performedDeficient service planSupport documentation deficient/missingTreatment plans deficient/missing
18
Fighting Fraud. Improving Integrity and Quality. Saving Taxpayer Dollars.
Examples of What to Disclose (continued)
Remember:
Payment for any service ordered by, or provided by, an excluded person is an overpayment requiring disclosure.
19
Fighting Fraud. Improving Integrity and Quality. Saving Taxpayer Dollars.
What to Submit
Letter or secure e-mail describing the overpayment Excel file of the overpayment claims billed to Medicaid
on a CD or in electronic format Statistical sampling:
Method must be submitted for review to OMIG Can be requested from OMIG
Underpayments must be re-billed to eMedNY
Note: Do not submit a check with your self-disclosure20
Fighting Fraud. Improving Integrity and Quality. Saving Taxpayer Dollars.
Method of SubmissionSubmissions containing protected health
information (PHI) should be sent by:
Secure e-mail, courier (Fed Ex, UPS, etc.), certified mail or
HMS Portal https://ecenter.hmsy.com/shr/controller
21
Fighting Fraud. Improving Integrity and Quality. Saving Taxpayer Dollars.
Method of Submission
E-mail may be used for the initial disclosure notification to OMIG and subsequent informal exchanges.
Direct e-mail to the Self-Disclosure Unit: [email protected]
22
Fighting Fraud. Improving Integrity and Quality. Saving Taxpayer Dollars.
The Process
Receive Disclosure Review the disclosure for completenessValidate Provider Disclosure
Submitted claims will be verified against the Medicaid database for accuracy and current payment amount
23
Fighting Fraud. Improving Integrity and Quality. Saving Taxpayer Dollars.
The Process (continued)
Confirm Findings with Provider Our staff will work with the provider to resolve
any issues.Finalize Disclosure Upon completion, a final letter will be sent to the
provider indicating completion of the case, the overpayment amount confirmed by OMIG, and the repayment requirements.
24
Fighting Fraud. Improving Integrity and Quality. Saving Taxpayer Dollars.
Repayment
Repayment instructions are included in the final letter.
25
Fighting Fraud. Improving Integrity and Quality. Saving Taxpayer Dollars.
We Want to Hear from YOU
Our new, improved Web site: www.omig.ny.govJoin our ListservFollow us on Twitter: @NYSOMIG“Like” us on FacebookDedicated e-mail: [email protected] than 4,500 final audit reportsAudit protocolsAnd much, much more!
26
Fighting Fraud. Improving Integrity and Quality. Saving Taxpayer Dollars.
How You Can Work With Us
27
Fighting Fraud. Improving Integrity and Quality. Saving Taxpayer Dollars.
Thank You
For listening to OMIG’s Webinar presentation today
For serving Medicaid consumersFor your commitment to integrity and quality
in the Medicaid program
28
Fighting Fraud. Improving Integrity and Quality. Saving Taxpayer Dollars.
Contact Information
Mary Kay DelGiaccoJohanna De Rosby
Self-Disclosure Unit StaffNew York State Office of the Medicaid Inspector General
800 North Pearl StreetAlbany, New York 12204-1822
518-402-7030
29
